Global collaboration is the cornerstone of scientific advancement. Frontiers in Nephrology has organized a series of special edition Research Topics, with the goal of highlighting the latest advancements in nephrology across the globe, showcasing the academic excellence and high-quality work of internationally recognized researchers. These collections aim to shed light on the recent progress made across the entire breadth of the nephrology field, and reflect on the future challenges faced by researchers across borders. Please note, contributions to the collection are by invitation only. Please inform the Editorial Office at nephrology@frontiersin.org once you are prepared to submit

Department of Nephrology, Peking Union Medical College Hospital (CAMS)

Shanghai Changzheng Hospital

First Hospital, Peking University

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Frontiers in Nephrology

Clinical Research in Nephrology

Blood Purification

Onconephrology

Glomerular disease

Critical Care Nephrology

Global Excellence in Nephrology: Asia and Australasia

Global collaboration is the cornerstone of current scientific advancement in nephrology. Within the realm of nephrology, the regions of Asia and Australasia have emerged as hotbeds of innovation, research, and clinical excellence. With a rich diversity of patient populations, unique healthcare challenges, and a strong commitment to advancing renal care, Asia and Australasia have become recognized for their contributions to global excellence in nephrology.In recent years, the field of nephrology in Asia and Australasia has undergone a remarkable transformation, leading to groundbreaking discoveries, improved patient outcomes, and a positive impact on public health. These achievements have been the result of concerted efforts by healthcare providers, researchers, and allied professionals who have strived to tackle the challenges posed by kidney diseases in the region.One of the key drivers of excellence in nephrology in Asia and Australasia has been the advancement of research and clinical practice. Researchers and clinicians in the region have made significant contributions to various aspects of nephrology, including hereditary nephropathy, renal pathology, glomerulonephritis classification, prognosis, and the development of new treatments. These advancements have not only deepened our understanding of kidney diseases but have also translated into tangible improvements in patient care, diagnosis, and treatment options.In this Research Topic, the study by <a href="https://doi.org/10.3389/fneph.2023.1105933">Guo et&nbsp;al.</a> investigated the clinical and pathological characteristics of patients with IgA nephropathy (IgAN) with and without associated minimal change disease (MCD). The study found that patients with MCD-IgAN had lower levels of serum galactose-deficient immunoglobulin A1 (Gd-IgA1) than those with non-MCD-IgAN but presented with higher levels than healthy participants. In comparison to non-MCD-IgAN, complement C3 activation in the circulation and the renal location was substantially weaker in MCD-IgAN. The authors suggest that IgAN with MCD might be MCD with coincidental IgA deposition. This study provided valuable insights into the clinical and pathological characteristics of patients with IgAN with and without MCD.In a second study, <a href="https://doi.org/10.3389/fneph.2022.935288">Liu et&nbsp;al.</a> investigated the relationship between serum phosphate levels and mortality in 23,283 septic patients. The study found that both hypo- and hyperphosphatemia were independent risk factors for mortality, and that dynamic changes in phosphate levels were also associated with increased mortality risk. There is a U-shaped association between serum phosphate levels and the risk of mortality in septic patients.A review by <a href="https://doi.org/10.3389/fneph.2023.1071441">Zhang et&nbsp;al.</a> provided an overview of the potential therapeutic effects of plant-derived compounds in treating autosomal dominant polycystic kidney disease (ADPKD), which is the leading hereditary kidney disease. The article highlighted the limitations of current drugs used to treat ADPKD and suggested that plant-derived compounds may offer a promising alternative. Plant-derived compounds, including saikosaponin-d, Ganoderma triterpenes, curcumin, ginkgolide B, steviol, resveratrol, Sparganum stoloniferum Buch.-Ham, Cordyceps sinensis, triptolide, quercitrin, naringin, cardamonin, gambogic acid, and olive leaf extract, have shown potential in delaying the development of cysts or improving renal function in ADPKD. These plant-derived compounds act on various signaling pathways involved in the pathogenesis of ADPKD, such as the RAS/MAPK pathway and intracellular calcium levels, and may serve as promising candidates for future therapeutic interventions.Despite the impressive strides made in nephrology, Asia and Australasia continue to face unique challenges in managing kidney diseases. The prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) remains high in these regions, driven by factors such as an aging population, increasing rates of diabetes and hypertension, and lifestyle changes. Limited healthcare resources, inadequate infrastructure, and disparities in access to specialized care pose significant hurdles to effective kidney disease management. The study by <a href="https://doi.org/10.3389/fneph.2022.916308">Nagai et&nbsp;al.</a> discussed the relationship between urban design and CKD. The prevalence of CKD has increased in Japan due to the aging population, and lack of physical activity is a major preventable risk factor for mortality in adults. Rural city planning in Japan can improve renal health outcomes by promoting walking, bicycling, and the use of public transportation, which can increase daily physical activity levels and access to specialized medical care. Moreover, multidisciplinary education without medication for obese populations can positively impact obesity through increased physical activity, and recreational walking is a dominant contributor to increasing step counts.To further overcome these challenges and enhance the level of care, collaborative approaches have emerged as vital components of achieving global excellence in nephrology. Regional alliances, research consortia, and professional networks have facilitated the sharing of knowledge, expertise, and best practices among nephrology communities in Asia and Australasia. By fostering multidisciplinary collaborations between clinicians, researchers, epidemiologists, geneticists, and allied healthcare professionals, these initiatives have catalyzed innovation, accelerated research progress, and promoted the development of region-specific policies and guidelines.In summary, the region of Asia and Australasia has emerged as a powerhouse of global excellence in nephrology, demonstrating remarkable advancements, overcoming challenges, and fostering collaborative approaches to enhance patient care. By leveraging research and addressing the evolving burden of kidney diseases, Asia and Australasia will continue to make significant contributions on a global scale to the field of nephrology and improve the lives of individuals affected by kidney diseases.All&#xa0;authors&#xa0;listed have made a substantial, direct, and intellectual&#xa0;contribution&#xa0;to the work and approved it for publication.We thank the authors of the research papers published in this Research Topic for their valuable contributions and the referees for their rigorous review. We also thank the editorial board of Frontiers in Nephrology, especially Bradley Smith, Kieran Wilson, and Emily Kaiser for their support.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The authors CX, ML, and SW declared that they were editorial board members of Frontiers at the time of submission. This had no impact on the peer review process and the final decision.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: Global excellence in nephrology: Asia and Australasia

IntroductionImmunoglobulin A nephropathy (IgAN) presents various clinical manifestations and pathological phenotypes. Approximately 5% of patients with IgAN present with early onset nephrotic syndrome, mild mesangial lesions, and diffuse foot process effacement of podocytes, which resemble minimal change disease (MCD). These patients are defined as MCD-IgAN. Whether MCD-IgAN is a special type of IgAN or simply MCD accompanied by IgA deposition remains controversial.</sec>MethodsA total of 51 patients diagnosed with MCD-IgAN at Beijing Anzhen Hospital from January 2010 to September 2022 were recruited. The clinical and pathological characteristics of IgA-MCD were analyzed. Patients with IgAN but without MCD (non-MCD-IgAN) and healthy participants were enrolled as controls. Galactose-deficient immunoglobulin A1 (Gd-IgA1) and complement C3 were detected both in the circulation and in renal tissues.</sec>ResultsWe found that the levels of serum Gd-IgA1 were lower in participants with MCD-IgAN than in those with non-MCD-IgAN, but higher than in healthy participants. Gd-IgA1 was rarely deposited in the glomeruli of participants with MCD-IgAN, with a positive rate of only 13.7% (7/51); in contrast, the positive rate in participants with non-MCD-IgAN was 82.4% (42/51). Among renal Gd-IgA1-positive patients, Gd-IgA1 and immunoglobulin A (IgA) colocalized along the glomerular mesangial and capillary areas. Interestingly, we found that the circulating levels of complement C3 were significantly higher in participants with MCD-IgAN than in participants with non-MCD-IgAN. In addition, the intensity of C3c in glomeruli in participants with MCD-IgAN was significantly weaker than in participants with non-MCD-IgAN.</sec>ConclusionsOur study suggests that, in MCD-IgAN, most of the IgA that is deposited on glomeruli is not the same pathogenic Gd-IgA1 as found in general IgAN. Complement activation both in the circulation and in the renal locality was much weaker in MCD-IgAN than in non-MCD-IgAN. Our study suggests that IgAN with MCD might be MCD with coincidental IgA deposition.</sec>

Introduction: Immunoglobulin A nephropathy (IgAN) presents various clinical manifestations and pathological phenotypes. Approximately 5% of patients with IgAN present with early onset nephrotic syndrome, mild mesangial lesions, and diffuse foot process effacement of podocytes, which resemble minimal change disease (MCD). These patients are defined as MCD-IgAN. Whether MCD-IgAN is a special type of IgAN or simply MCD accompanied by IgA deposition remains controversial.Methods: A total of 51 patients diagnosed with MCD-IgAN at Beijing Anzhen Hospital from January 2010 to September 2022 were recruited. The clinical and pathological characteristics of IgA-MCD were analyzed. Patients with IgAN but without MCD (non-MCD-IgAN) and healthy participants were enrolled as controls. Galactose-deficient immunoglobulin A1 (Gd-IgA1) and complement C3 were detected both in the circulation and in renal tissues.Results: We found that the levels of serum Gd-IgA1 were lower in participants with MCD-IgAN than in those with non-MCD-IgAN, but higher than in healthy participants. Gd-IgA1 was rarely deposited in the glomeruli of participants with MCD-IgAN, with a positive rate of only 13.7% (7/51); in contrast, the positive rate in participants with non-MCD-IgAN was 82.4% (42/51). Among renal Gd-IgA1-positive patients, Gd-IgA1 and immunoglobulin A (IgA) colocalized along the glomerular mesangial and capillary areas. Interestingly, we found that the circulating levels of complement C3 were significantly higher in participants with MCD-IgAN than in participants with non-MCD-IgAN. In addition, the intensity of C3c in glomeruli in participants with MCD-IgAN was significantly weaker than in participants with non-MCD-IgAN.Conclusions: Our study suggests that, in MCD-IgAN, most of the IgA that is deposited on glomeruli is not the same pathogenic Gd-IgA1 as found in general IgAN. Complement activation both in the circulation and in the renal locality was much weaker in MCD-IgAN than in non-MCD-IgAN. Our study suggests that IgAN with MCD might be MCD with coincidental IgA deposition.

Characterization of patients with IgA nephropathy with and without associated minimal change disease

Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic hereditary kidney disease, is the fourth leading cause of end-stage kidney disease worldwide. In recent years, significant progress has been made in delaying ADPKD progression with different kinds of chemical drugs, such as tolvaptan, rapamycin, and somatostatin. Meanwhile, numerous plant-derived compounds have been investigated for their beneficial effects on slowing ADPKD progression. Among them, saikosaponin-d, Ganoderma triterpenes, curcumin, ginkgolide B, steviol, resveratrol, Sparganum stoloniferum Buch.-Ham, Cordyceps sinensis, triptolide, quercitrin, naringin, cardamonin, gambogic acid, and olive leaf extract have been found to retard renal cyst development by inhibiting cell proliferation or promoting cell apoptosis in renal cyst-lining epithelial cells. Metformin, a synthesized compound derived from French lilac or goat’s rue (Galega officinalis), has been proven to retard the progression of ADPKD. This review focuses on the roles and mechanisms of plant-derived compounds in treating ADPKD, which may constitute promising new therapeutics in the future.

Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic hereditary kidney disease, is the fourth leading cause of end-stage kidney disease worldwide. In recent years, significant progress has been made in delaying ADPKD progression with different kinds of chemical drugs, such as tolvaptan, rapamycin, and somatostatin. Meanwhile, numerous plant-derived compounds have been investigated for their beneficial effects on slowing ADPKD progression. Among them, saikosaponin-d, Ganoderma triterpenes, curcumin, ginkgolide B, steviol, resveratrol, Sparganum stoloniferum Buch.-Ham, Cordyceps sinensis, triptolide, quercitrin, naringin, cardamonin, gambogic acid, and olive leaf extract have been found to retard renal cyst development by inhibiting cell proliferation or promoting cell apoptosis in renal cyst-lining epithelial cells. Metformin, a synthesized compound derived from&nbsp;French lilac&nbsp;or goat’s rue (Galega officinalis), has been proven to retard the progression of ADPKD. This review focuses on the roles and mechanisms of plant-derived compounds in treating ADPKD, which may constitute promising new therapeutics in the future.

Plant-derived compounds for treating autosomal dominant polycystic kidney disease

BackgroundTo report an unusual case of minimal change nephrotic syndrome with sudden bilateral retinal detachment.</sec>Case presentationA 54-year-old woman with minimal change nephrotic syndrome presented with sudden-onset visual blurring in both eyes. Optical coherence tomography scans revealed macular schisis and extramacular intraretinal separation. A kidney biopsy confirmed the diagnosis of minimal change disease. Glucocorticoid therapy was quickly started. During remission, her vision was restored, with complete resolution of the subretinal fluid observed on optical coherence tomography.</sec>ConclusionsIn minimal change nephrotic syndrome, fluid accumulation in the retina layer may occur, and gravity-induced vitreous traction on the inferior retina may cause retinal detachment. Patients should be advised to avoid large swings of the head and neck, handstands, and other activities that may increase the risk of retinal detachment. The possibility of retinal detachment should be considered when blurred vision occurs.</sec>

Background: To report an unusual case of minimal change nephrotic syndrome with sudden bilateral retinal detachment.Case presentation: A 54-year-old woman with minimal change nephrotic syndrome presented with sudden-onset visual blurring in both eyes. Optical coherence tomography scans revealed macular schisis and extramacular intraretinal separation. A kidney biopsy confirmed the diagnosis of minimal change disease. Glucocorticoid therapy was quickly started. During remission, her vision was restored, with complete resolution of the subretinal fluid observed on optical coherence tomography.Conclusions: In minimal change nephrotic syndrome, fluid accumulation in the retina layer may occur, and gravity-induced vitreous traction on the inferior retina may cause retinal detachment. Patients should be advised to avoid large swings of the head and neck, handstands, and other activities that may increase the risk of retinal detachment. The possibility of retinal detachment should be considered when blurred vision occurs.

Retinal detachments in a patient with minimal change nephrotic syndrome: Case report and review of the literature

ObjectiveThis study was intended to explore the relationship between level of serum phosphate and prognosis in septic patients.</sec>MethodsData were obtained from the public database, which were divided into 2 subgroups according to whether they were complicated with chronic kidney disease. Initial values of serum phosphate were extracted from patients on admission to hospital. Propensity score-matched analysis was performed. The relationship between hypophosphatemia, hyperphosphatemia and the severity of the disease in septic patients was explored separately. The lowess smoothing technique and the Kaplan-Meier method were utilized for a preliminary analysis of serum phosphate levels in relation to in-hospital mortality and 28-day survival. The initial values of serum phosphate were graded as level 1 (<1.5 mg/dL), level 2 (1.5-2.7 mg/dL), level 3 (2.7-4.5 mg/dL), level 4 (4.5-5.5 mg/dL), level 5 (5.5-6.5 mg/dL), level 6 (6.5-7.5 mg/dL) and level 7 (> 7.5 mg/dL). Multivariate logistic regression and cox regression was used to analyse the relationship between serum phosphate levels and mortality.</sec>ResultsThere were 4059 cases (17.4%) combined with chronic kidney disease, including 419 cases (10.3%) with hypophosphatemia and 1091 cases (26.8%) with hyperphosphatemia. There were 19224 cases (82.6%) not combined with chronic kidney disease, including 3769 cases (19.6%) hypophosphatemia and 2158 cases (11.2%) hyperphosphatemia. After propensity score-matched, in-hospital mortality, 28-day mortality, risk of septic shock was significantly higher in the 2 subgroups of hypophosphatemia patients than in normophosphatemia patients. In-hospital mortality, 28-day mortality, risk of septic shock, occurrence of renal replacement therapy, occurrence of acute renal failure, and maximum clinical score were all significantly higher in the 2 subgroups of patients with hyperphosphatemia than in patients with normophosphatemia. Multivariate logistic regression was consistent with cox regression results. In septic patients without chronic kidney disease, hypophosphatemia was an independent risk factor for death. When serum phosphate was lower, the risk of death was higher. In all septic patients, hyperphosphatemia was an independent risk factor for death. When serum phosphate was higher, the risk of death was greater.</sec>ConclusionsBoth hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients and are independent risk factors for death.</sec>

Objective: This study was intended to explore the relationship between level of serum phosphate and prognosis in septic patients.Methods: Data were obtained from the public database, which were divided into 2 subgroups according to whether they were complicated with chronic kidney disease. Initial values of serum phosphate were extracted from patients on admission to hospital. Propensity score-matched analysis was performed. The relationship between hypophosphatemia, hyperphosphatemia and the severity of the disease in septic patients was explored separately. The lowess smoothing technique and the Kaplan-Meier method were utilized for a preliminary analysis of serum phosphate levels in relation to in-hospital mortality and 28-day survival. The initial values of serum phosphate were graded as level 1 (&lt;1.5 mg/dL), level 2 (1.5-2.7 mg/dL), level 3 (2.7-4.5 mg/dL), level 4 (4.5-5.5 mg/dL), level 5 (5.5-6.5 mg/dL), level 6 (6.5-7.5 mg/dL) and level 7 (&gt; 7.5 mg/dL). Multivariate logistic regression and cox regression was used to analyse the relationship between serum phosphate levels and mortality.Results: There were 4059 cases (17.4%) combined with chronic kidney disease, including 419 cases (10.3%) with hypophosphatemia and 1091 cases (26.8%) with hyperphosphatemia. There were 19224 cases (82.6%) not combined with chronic kidney disease, including 3769 cases (19.6%) hypophosphatemia and 2158 cases (11.2%) hyperphosphatemia. After propensity score-matched, in-hospital mortality, 28-day mortality, risk of septic shock was significantly higher in the 2 subgroups of hypophosphatemia patients than in normophosphatemia patients. In-hospital mortality, 28-day mortality, risk of septic shock, occurrence of renal replacement therapy, occurrence of acute renal failure, and maximum clinical score were all significantly higher in the 2 subgroups of patients with hyperphosphatemia than in patients with normophosphatemia. Multivariate logistic regression was consistent with cox regression results. In septic patients without chronic kidney disease, hypophosphatemia was an independent risk factor for death. When serum phosphate was lower, the risk of death was higher. In all septic patients, hyperphosphatemia was an independent risk factor for death. When serum phosphate was higher, the risk of death was greater.Conclusions: Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients and are independent risk factors for death.

Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients

Progression of chronic kidney disease (CKD) is a substantial threat because it is associated with reduced healthy life expectancy and quality of life, and increase in economic burden. Research indicates people with nondialysis CKD often have lower physical functioning and that improvement of physical activity may contribute to maintaining renal health. Another issue with the current treatment of CKD is that the synergistic effects of rural depopulation due to aging and uncontrolled rural city sprawling will increase the number of under-served healthcare areas. To ensure the quality of renal health care, hospital integration is desirable, under the condition of reconstruction of the public transport system for physically and socially vulnerable people. Recently, medical and non-medical scientists advocate the challenge of city planning for population health. The links between city design and health such as cardiovascular disease, obesity, type 2 diabetes and mental disorders, have been widely studied, except for renal health. Based on our experience in a Kidney and Lifestyle-related Disease Center, we propose the idea that city planning be prioritized to improve renal health through two main streams: 1) Improve physical status by use of public and active transportation including daily walking and cycling; and 2) Equal accessibility to renal health services. Many countries, including Japan, have enacted plans and public policy initiatives that encourage increased levels of physical activity. We should focus on the impact of such movement on renal as well as general health.

Progression of chronic kidney disease (CKD) is a substantial threat because it is associated with reduced healthy life expectancy and quality of life, and increase in economic burden. Research indicates people with nondialysis CKD often have lower physical functioning and that improvement of physical activity may contribute to maintaining renal health. Another issue with the current treatment of CKD is that the synergistic effects of rural depopulation due to aging and uncontrolled rural city sprawling will increase the number of under-served healthcare areas. To ensure the quality of renal health care, hospital integration is desirable, under the condition of reconstruction of the public transport system for physically and socially vulnerable people. Recently, medical and non-medical scientists advocate the challenge of city planning for population health. The links between city design and health such as cardiovascular disease, obesity, type 2 diabetes and mental disorders, have been widely studied, except for renal health. Based on our experience in a Kidney and Lifestyle-related Disease Center, we propose the idea that city planning be prioritized to improve renal health through two main streams: 1) Improve physical status by use of public and active transportation including daily walking and cycling; and 2) Equal accessibility to renal health services. Many countries, including Japan, have enacted plans and public policy initiatives that encourage increased levels of physical activity. We should focus on the impact of such movement on renal as well as general health.